Background: Patent ductus arteriosus (PDA) is a common congenital heart disease. While newer interventions have surfaced, surgery is still the mainstay of treatment. The approach is via a left posterolateral thoracotomy. The PDA is then ligated or transected. A chest tube has traditionally been inserted prior to chest closure. However, there has been an increasing trend in closing the chest without inserting a chest tube. Previous studies have shown this to be a safe approach.
Objectives: This study compared the complication rates between inserting and not inserting a chest tube after PDA closure.
Methods: This is a cohort study involving pediatric PDA closure patients. Patients included in the study were gathered from a chart review from 2005 to 2010 and a prospective cohort group from 2011 to 2013. All pediatric PDA patients who had isolated PDA closure via a thoracotomy approach at Philippine Heart Center were included in the study. There were grouped as follows: Group 1 - with chest tube inserted and Group 2 - no chest tube inserted. Complications were recorded from both groups and complication rates were compared between the two groups.
Results: A total of 169 patients comprised the study population, with 33 comprising the group where chest tubes were inserted after surgery (Group 1) and 136 comprising the group where chest tube insertion was not done (Group 2). Regardless of the type of closure, most patients (n= 136) did not have a chest tube at the end of the procedure. However, patients who were older tended to have a chest tube inserted for them at the conclusion p<0.0001). Overall complications were more frequent in Group 2 (38 vs 23); however, in terms of complications needing 19 intervention, Group 1 had two, while Group 2 had one. Length of stay in the intensive care unit was significantly shorter for the group without a chest tube (1.10±1.24 days vs 1.68± 1.27 days; p = 0.0169)length of post-op stay tended to be shorter for Group 2, but this did not achieve statistical significance (4.26±3.07 vs 5.30±2.44; p=0.0723).
Conclusion: This study showed that, while not inserting a chest tube is associated with a number of complications and a relatively high complication rate, these complications were minor and did not entail further intervention. Also, not inserting a chest tube was associated with shorter ICU and hospital stay.